Persons with serious mental illness (SMI) have two to over three times the mortality rate compared to the overall population, primarily dying of medical causes. Yet, they often face challenges accessing appropriate primary care. Under the Affordable Care Act Health Home provision, states may receive federal matching funds for screening, coordinating, providing, and monitoring medical and mental health care for vulnerable populations including SMI. Maryland plans to commence the initiative in mid-2013, focusing on psychiatric rehabilitation programs, serving SMI with high need for services, as providers of the health home. Core components of the health home will include comprehensive care management, care coordination, individualized treatment plans, community resource linkages and use of health information technology. Through this R24, we have the unique opportunity to study this natural experiment from the inception of Maryland's health home initiative. Our research team is highly qualified with expertise in health policy, intervention studies to improve overall health in SMI, implementation science and analysis of Medicaid data. In partnership with the Maryland Department of Health and Mental Hygiene and mental health provider stakeholders, we propose the following Specific Aims: 1) Develop and analyze a cohort of Medicaid recipients with SMI to assess use and quality of primary care; 2) Assess stakeholders' perceived needs and intentions, and organizational factors with regard to health homes in rehabilitation programs and 3) Provide technical assistance to stakeholders focusing on a) formation of a learning collaborative; b) guidance on health promotion activities and successful coordination among providers; and c) training health home staff to collect research quality measurements for weight, BMI, blood pressure, waist circumference and expired carbon monoxide. Embedding expertise in research measurements in the community is highly innovative and will provide an important capability to leverage in a future evaluation. Accomplishing the aims in this R24 will provide valuable preliminary work and an excellent foundation for a future R01 to rigorously evaluate Maryland's health home initiative with goals to improve health care and health outcomes in SMI.